This Blog is about one person's search for a holistic protocol for ME/CFS (myalgic encephalomyelitis / Chronic Fatigue Syndrome) and Lyme Disease

Saturday, February 17, 2007

Cautions about Salt/C

A number of reports of serious negative reactions to trials of salt/c have been appeared recently, prompting me to carefully re-evaluate safety issues related to the protocol. Although I had some worrysome symptoms myself initially on salt/c, including some heart palpitations, chest pain, occasional upper left arm pain and kidney area pain, most of that went away when I lowered my dose, or when I took supplements to support each of those systems. I had attributed those events to the herx response so often mentioned in the salt/c forums and although I was worried about the symptoms from time to time, the benefits from salt/c were often substantial and I believed the idea that these were normal herx symptoms. However, after receiving several reports of serious reactions to salt/c, I decided to do some homework. And what I found has changed my views of salt/c significantly.

The views of salt/c safety were initially based in the idea that historically our ancesters consumed a LOT of salt. In retrospect, that was not a very scientific basis for the safety of salt/c. After some research into safety issues, I have compiled the following list of cautions regarding salt/c safety, particularly for people who may unknowingly have salt intolerance, or related problems. This may be a small percentage of people trying salt/c, but they should not be ignored. Everyone needs to know because there is no way to guess who will be at risk. This should be clear as you read through the list. I believe these points are ESSENTIAL to share with anyone considering a trial of salt/c. Please note that these are based on my own study of the research, and should only be considered as potential issues, and certainly not the final word. Hopefully serious researchers in the biological sciences will eventually weigh in on the safety of salt/c.

1. Salt intolerance symptoms are different from herx symptoms. A herx from killing the Lyme bacteria is well-documented and can involve low-grade fever, slight increase in general symptoms, some immune activation (cold symptoms), things like that. In contrast to this, based on reports, a salt intolerance event can involve kidney area pain, severe thirst, edema, extreme mood swings (possibly due to electrolyte imbalances), heart or chest area pains, palpitations, left arm pains, severe shortness of breath, visual disturbances, motor problems, etc.

2. If you have symptoms of salt intolerance you should stop salt/c IMMEDIATELY and begin drinking extra water to help flush out the excess sodium. Just ramping down may not be adequate.

3. Salt intolerance is a type of poisoning. What may be happening is that the aldosterone levels are unable to suppress to allow the body to remove excess sodium. This means the sodium levels are building up to a high level. So even a low dose of salt may be having the same effect on a salt intolerant person as if they had taken a very, very high dose of salt.

4. When a body can not regulate sodium levels well, chronic intake of salt may create hypertension. This is known to damage the kidneys over time. Therefore, a salt intolerant person who persists with salt/c may be putting their kidneys at risk of injury.

5. Human tolerance for salt varies tremendously, by as much as 300%. Therefore some people may benefit from doses of salt that may be dangerous for other people. We are not at all uniform in our ability to eat salt. So if you have symptoms of salt intolerance, take them seriously.

6. People who have pre-existing risk factors, such as kidney problems or potassium deficiencies, may be much more at risk of intolerance of salt/c, and this is probably amplified if they also have a genetic ACE mutation. Even if a Lyme sufferer's kidneys are relatively strong, they might still be unable to tolerate salt/c, due to an overload of toxins from Lyme or other co-infections, mineral balance problems leading to low potassium (which is certainly possible with some mineral-depleting co-infections), or endocrine regulation problems in the adrenals. Also, kidneys do not produce symptoms until they have lost 70-80% of their function, so some people with kidney problems may not even know they have that risk factor. And they may have no awareness of low potassium levels. Therefore, nobody can ignore the possibility that they may have unknown risk factors that contraindicate salt/c. So everyone trying salt/c should become aware of the difference between salt intolerance and herx, and monitor their response accordingly.

7. The lowest research-based level at which salt becomes toxic and can cause symptoms and some damage is generally given as 0.5g/kg (see the first reference below for this). The lowest number where salt becomes a lethal poison is 1.0g/kg, just double the toxic dose. [reference: http://ToxNet.nlm.nih.gov ] Therefore, for a healthy 60 kilo person (132 lbs), this means the toxic dose starts at 30g. That would presumably be a single 30g dose. The Salt Institute says that a teaspoon of salt weighs 6 g. Therefore, 5 teaspoons of salt taken over a short period of time would be considered a toxic dose. Since nobody is recommending salt/c be taken in doses that large, we would seem to be safe. However, remembering the huge variation in salt tolerance, consider the extreme scenario where a person is salt sensitive (has the ACE mutation), and also has low potassium or a diminished kidney function (for whatever reason, including overload). Their toxic dose may be much lower, perhaps only 1-2 teaspoons couldhave the same effect on them as a 5 teaspoon dose on a health person. Some people on salt/c have reported taking 1 teaspoon doses at a single time. This could be a toxic dose level for some people. Although this would not be a lethal dose, their kidneys might be damaged from a dose this low (see references below for information about ways the kidneys are damaged from excessive salt). Also, remember that a lethal dose starts at double the toxic dose. These people might tolerate a low dose of salt/c, but should probably NOT be on a therapeutic dose of salt/c.

8. The research literature about health effects of salt includes cases where salt became poisonous because the person was under-hydrated. If a person is not drinking adequate fluids, a dose of salt/c may have an amplified effect. This is another route to creating a toxic response to salt/c. Therefore, if a person is not willing or able to monitor their fluid intake, they should not be on salt/c.

9. Large doses of salt increase the excretion of metals. In fact, large doses of salt are recommended for lithium intoxication, to get the lithium out of patients who have had drug overdoses. If a person has poorly functioning detoxification, such as bad methylation and low glutathione, and also has a toxic metals load, this could cause problems and compound the herx effects. Also, some metals could be redistributed if the detoxification system can not handle the load of metals releaased by salt/c. On the other hand, if a person has good metals detox and clearance, salt/c might actually be beneficial for reducing metals load. But there are many genetic variations in detoxification potential so this is VERY unpredictable on a case-by-case level. Genetic testing is available to assess methylation status (see the links on the Yahoo list 'CFS_Yasko').

10. Due to the risks mentioned above, prudence indicates that people on salt/c should be following a slow ramp-up protocol precisely, and then tracking and monitoring their symptoms. They should be writing doses, and symptoms down in a log, in order to provide objective data to help them determine the type of reaction they are having. Given the hopefulness many people have towards salt/c, there may be some tendency to forget how 'bad' a person felt, so brutal honesty is required in this type of logging of the experience of the protocol.

11. If a person tends to have problems following protocols and is unable or unwilling to precisely follow the ramp-up, and track the results carefully, they should not be on salt/c. In particular this applies if they are taking the granulated salt in water and sipping it throughout the day. That can cause some people to take larger doses at one time than they realize. A better strategy is to make each dose separately, so there is no risk of overdosing when sipping throughout the day.

12. IF a person has ANY reason to suspect that they have heart or kidney weaknesses, or that they may have the ACE mutation (most people with CFS may have this), or if they know that they have any other the risk factors, they should not be on salt/c without careful monitoring of their progress, and if possible medical supervision. In fact, if any very unusual symptoms emerge that are not part of an ordinary herx (mild increase in symptoms), they should probably re-consider using salt/c until they better understand their own risk factors. Treating new symptoms that they have never experienced before with supplements may be hiding an underlying salt intolerance.

13. A number of studies have correlated high salt intake with a variety of cancers, most often stomach cancer. Although there may be other factors in the diet of the people in those studies (I believe the main studies are Japanese), this should give everyone a small pause about salt/c. If a person knows that they are in a high risk category for cancer, such as having stomach cancer in their immediate family, they should consider carefully whether salt/c is for them.

14. A 'cowboy up' or 'tough it out' philosophy of ignoring strong herx symptoms and just pushing oneself through seen in some online discussions could be extremely dangerous for people who happen to be salt intolerant. This notion should be banned from any online discussion of salt/c since salt intolerant people could be harmed as a result. The fact that simply enduring and ignoring strong herx symptoms works for some people does not mean it is safe for all. Cowboy up is like playing Russian Roulette, gambling that you are not the person with the bad salt genes, overloaded kidneys, etc.

15. People with CFS often have diminished bloodflow in the kidneys, one study shows that bloodflow is about 50% of normal, for most people with CFS. Therefore, a person with Lyme who also has CFS may be at higher risk for any treatment that produces strain on the kidneys. In my own case even after nearly two years of salt/c, I only tolerated a half dose strategy, meaning I only was able to tolerate half of the suggested salt/c doses. In retrospect, that may have been due to this kidney bloodflow issue with CFS. Therefore a person with CFS who decides to take a chance on salt/c should probably set a lower target dose, half dose seems to work for some with CFS.

Anonymous,That lymeblog post is interesting, although I think a bit sensationalistic. If illness such as Lyme causes electrolyte imbalances, salt/c might be very helpful, for that reason alone.

I am not promoting nor making claims about salt/c. Rather, I am trying to present a reasoned argument that is unbiased about a natural self-treatment that is being oversold. Thus you see my warnings above.